Device for bending fracture nails and the like for impacting fractures and extracting such nails



- March 25, 1952 E. J. HABousH 2,590,532 DEVICE FOR BENDING FRACTURENAILS AND THE LIKE FOR IMPACTING FRACTURES AND EXTRACTING SUCH NAILSFiled NOV. 30, 1949 2 SHEETS--SFEET HIS ATTORNEYS.

March 25, 1952' 2,590,532

G FRACTURE NAILS AND THE LIKE F0 S L .I A N H C U S G N n w m u m. H m DN H A m w E m M I A D R N F E B G m T C E A w II V E D 2 SHEETS-Si-EET 2Filed Nov. 30, 1949 unk g 22 Fall??? INVENTOR.

EDWARD J. HABOUSH f BY (I M 'W.:FAMY

HIS ATTORNEYS.

Patented Mar. 25, 1952 UNITED STATES PATENT OFFICE DEVICE FOR BENDINGFRACTURE NAILS AND THE LIKE FOR IlHPACTING FRAC- TURES AND EXTRACTINGSUCH NAILS Claims.

This invention relates to surgical instruments and it relatesparticularly to instruments for bending, inserting and removing nailsand bone plates used for the reduction and fixation of fractures,especially fractures of the hip.

In reduction of fractures of the hip, as Well as other fractures, it hasbecome rather common practice to reinforce and fix the fracture by meansof bone nails or pins, bone plates or combined nails and plates whichare driven into the bone fragments and/or secured to them to span thefracture to fix the fragments relative to each other so that they mayknit together. In many cases, the use of these artificial reinforcingelements permits the use of the fractured member while the fracture isknitting or healing.

When combined nails and bone plates are used for the fixation offractures atthe neck of the femur, one end of the nail and bone plate isdriven into the fragments so that it spans the fracture with the end ofthe nail embedded in the ball of the femur. The remainder of the nailand bone plate is bent down and fastened to the shaft of the femur bymeans of screws to form a strong and rigid connection across the neck ofthe femur.

One of the difficulties encountered in this type of fracture fixation isthe bending of the nail and bone plate to the proper angle so that theprojecting portion of the plate lies parallel with the shaft of thefemur.

Nail and bone plates must be strong and relatively rigid so that motionbetween the bone fragments is prevented, even when the patient ispermitted use of the fractured member. Because of this rigidity, it ismost diflicult to bend the plate to the desired angle with theinstruments now available. Especially it is not possi ble to do thiswhen the nail, and plate has been driven into the bone and is in thebest position to determine the angle to which the protruding portion ofthe nail and plate must be bent to render it parallel to the bone.Therefore, it is customary to bend the plate or nail prior to driving itinto the bone. Such bending produces, at best, only an approximation ofthe correct angle. Moreover, the bent condition of the nail makes itdifficult to drive and guide the nail accurately into the bone.

The present invention provides an instrument which overcomes thedisadvantages of prior nail bending devices, and makes possible easy andaccurate bending of such bone nails and plates.

A typical embodiment of the invention may include a pair of relativelymovable anvil members which support a nail or nail plate in contact witha fulcrum member closely adjacent to the bone. The anvil members arefirst moved into alignment to engage a straight nail or plate and thenare moved relatively to bend the nail around predetermined angle.

The device is provided with power multiplying means so that while it iscompact and convenient to manipulate, sufiicient power may be developedat the anvils to bend the most rigid types of nails and platesavailable.

Moreover, the instrument may include an impactor for seating the bonefragments and this impactor may be used in conjunction with the bendingelements to drive the nail into the bone and to withdraw the nail fromthe bone if it is inserted improperly or too deeply.

For a better understanding of the present invention, reference may behad to the accompanying drawings, in which:

Fig. 1 is a view in side elevation of a typical bending and impactinginstrument embodying the present invention;

Fig. 2 is a bottom plan view of the instrument shown in Fig. 1;

Fig. 3 is a view in elevation of the head of the instrument which ispartly broken away to disclose details thereof;

Fig. 4 is a view in section taken on line 4-4 of Fig. 2;

Fig. 5 is a view partially in side elevation and partially in sectionand of a part of the instrument broken away showing an adjusted positionthereof; and

Fig. 6 is a view in section of a detail of the instrument illustrating adifferent relation of the parts thereof.

The instrument chosen for purposes of illustration is constructed foruse with combined nails, nail plates and nail and bone plates of thetype disclosed in my copending application Serial No. 782,503, filedOctober 28, 1947, and now Patent No. 2,496,126. Nails and nail boneplates of the type disclosed in the application will be referred tohereinafter as nails for brevity. These nails are generally I-shaped incross-section.

The instrument is designed to accommodate the flanges on the I-shapedsection, but it will be understood that the device can be modified toreceive and bend other types of nails and plates than the nailsdisclosed in the abovementioned application.

As best shown in Figs. 1 and 2, the nail bend- 5 nected to theright-hand end of a the handle I0, as viewed in Fig. 1 and projectoutwardly therefrom at an acute angle to the axis of the handle. Thefulcrum pin I3 is mounted in the ends of the arms I4 and I5 by means ofa pair. of externally threaded sleeves I6 and. H which" arescrewed intothearms I4- and I5- and have non-threaded end portions I8- whichprojectbeyond the innersurfaces of the arms; for

example; the arm I4, asshown in Fig. 3, to forma' bearing or hearingsleeve for supporting the anvil members II and- I2; aswill be described.Each of the sleevemembers I6 and I! also is internally threaded for aportion of its' length to-receivethe threaded enlargement I9 on thefulcrum pin I3. The inner ends ofthe sleeves I6 and I1 are smooth andserve-as bushingsfor receiving the reducedportion of the pin I3-. Thepin- I3 may also be provided with an enlarged head 20" and a cross pin2I- to facilitate its rotation to insert it and remove it from-thesleeves I6 or IT. The pin I3- can be inserted through either of thesleeves I6 and I1 as may be desired and depending upon theconvenience tothe operator;

' The sleeves Iii-and I-I support a U-shaped member 22 whiclihas itsbase formed by the anvil member I'l The ar'msg24 and 25 f" the U SIiapedmember 22- on the oppositeside of the pivot-pin I-3' from the anvil I12are-inclined at an obtuse angle to a line extendingthrough the axis-ofthe pivot I3=normal to the; adjacent face of'the-anvil' I2;

of a: toggle system by means -of which the anvil member I2 can be rockedaroundthefulcrum' pm I3. The other arm of thetoggle'co'nsists of a:=-shaped member- 26iliaving sp aced' apart arms 21 and 28 connected bymeans of pivot screws 29--and 30 to=the-ends of the: arms 24and25; re-

spectively. The opposite end of the Y-shaped linls 26 is connectedbetween. a pairoflugs-3| and? 3.2 extending from atubular internallythreaded. sleeve member 33 which'is slidable axially within the handleIll. The lugs illan'd 321fei'rter'idz' through a guide slot" I 0aextending lengthwise of the handle If]; Y

Upon sliding movement of the sleeve 33' to the rig-lit, asviewed' in-Figs. 4'- and the anvil member I2? isrocked counterclockwise aroundthe: pivot and upon sliding movement of the. sleeve; 33-tozthe-1left'-,.the anvil member I2. is

rocked clockwise around the; pivot. Sliding,

movement .of' the sleeve isproduced. by, means.

of. an externally threadedtubular member 34. mounted within. the handle.I Ilandthreaded into.

the sleeve 33;

Asbest shown. inEig. 4, the tubularmember S'Hias at its l'ef-t-handiend.anreduced unthreadedtubular. portion.-v 35=which is rotatable. in theopening 36 in the left-hand end of the handle (Figs.- 4; 5'- and 6.) Thearms 24 and 25 of the member-22form one-arm- I0 formed by the inturned,fiange 31. The member 34 has an enlarged collar 38 which bears againstthe flange 31 and limits movement of the member 34 to the left.

Movement of the threaded member 34 to the right is prevented by means ofthe operating handle 33 including a disc-like portion 46 having aninternal circular recess M for receiving the left-hand end of the handleIII. The handle 39 has an internal bore 42 receiving the sleeve portionand is secured thereto against relative. rotation by means of a suitablekey 43 or its equivalent. The handle 39 is retained in position by meansof a lock nut 44 threaded on the-outer end of the'sleeve portion 35 andabutting the tubular extension 45 on the handle 39.

To facilitate rotation of the handle 39, it may be provided withoutwardly extending rods 45 and 41 (Figs. 1 and 3) by means of whichmore power-can-beapplied to the-tubular member 34.

Inasmuch as the-handle-39-abuts the end of the handle I6, rotation ofthehandle 39 relative to the handle- IIl will cause the sleeve 33 tomove.

lengthwise-of the handle- I0,- thereby rocking theanvil member I2 asdescribed above.

As'best shownin Fig. 2, the surface 23 of the anvil member 12 isprovided-with a pair of spaced apart grooves 48- and-49- defined byspaced apart ribs 50 and 5I substantially fitting the cross-sectionalshapeof thenail-N to holdit against lateral sliding movement.

The anvil II is provided with similar aligned groovesand' ribs so thatit can engage a portion of-thenail adjacent to that supported by theanvil I2- when the anvil members II and I2 are in alignment, as showninFigs. land 6.

The'anvil member- II is also supported on the bearing sleeves I8 ofthemembers I6 and I1 for rocking movement relative to the arms I4'and I5.As best shown in Figs. 3 and 6, the anvil member II is supported on thesides of a pair of spaced arms 53 and 54 disposed between the arms 24and 25 of the U-shaped member 22.

Above and behind the grooved surface of the anvil member II is anarcuate surface formed with ratchet teeth' 55 by means of which theangular position of the anvil member around the fulcrum pin I3 can becontrolled. The anvil member I I is held in adjusted position by meansof a pawl member 56 having a pawl tooth 5I and a hollow'cylindricalbarrel portion'58 fixed toa cross' pin 59 which is rotatably mounted in"apertures in the arms I4 and I5. Theend of the cross pin.59"is bentlaterally and is flattened to form an actuating ,lever 60,by means ofwhich the pawl member. 56 can be rocked to disengage the pawl tooth 5!from" the ratchet 55. The ratchet 55 and the anvilQmember; I I arenormally urged clockwise as'.viewe.d in Figs.14. 5 .andifi. by: meansofa looped spring 6| having one" end; 62'

bent laterally and engaging. in a holein' the. side of the anvil memberI I.

towardthe. ratchet 55. In thisway, the pawl andtheratchet are alwaysurged towardeach other so as to retain the anvil member. .I I against.

rotation in-. a. clockwise direction. unlessthe .pawl

isretracted, whereupon .the anvil member. It will. swing into.engagementlwith thelside. of. thevanvil Its opposite end is bent.aroundthebarrel 58.of thepawl and engages in. an aperture therein tonormally urge the pawl nism affords accurate control of the extent ofbending of the nail.

The anvil member [2 is limited in its angular displacement by the extentof movement of the sleeve 33 relative to the handle it so that the totalmovement of the anvil member l2 in a typical instrument will be in theneighborhood of 60. Therefore, if the anvil member [2 is rocked in acounterclockwise direction to its limit of movement and the anvil memberll isaligned with it so that the nail N is in fiat engagement with thesurfaces of both of the anvil members, the nail can be bent to a 60angle by rotating the handle 39 to cause the sleeve33 to move to itslimit of travel, as shown in Fig. 5. Assuming that the pawl 57 engagesthe uppermost tooth of the ratchet 55 when the anvil I2 is inalignmentwith the anvil H, the nail will be bent by movement of theanvil member l2 through an angle of 60. For less'er angles, the pawlmember 56 is released so that the anvil member H can swing around in aclockwise direction to permit one of its lower teeth to engage the pawl56 when the latter is released. By suitably spacing the teeth of theratchet 55 and providing a scale S (Fig. 1) on the face of the anvilmember II, it is possible to bend the nail N through any of a series ofangles of predetermined values.

The anvil member II is adjustable to increase the angularity of bendingby rotating the handle 39 insuch a direction as to bring the anvil l2 upagainst the anvil I I, as shown in Fig. 4, and continuing the rotationin a direction to further collapse the toggle so that the anvil memberII is rocked against the action of the spring 6| in a counterclockwisedirection to engage the pawl 55 with successively higher teeth on theratchet, as

shown in Fig. 6.

In use, the anvils H and l2 may be adjusted to approximately the desiredangle to which the nail is to be bent by reference to the scale S. Thehandle 39 then is turned to grip the nail firmly between the anvilmembers H and I2 and the fulcrum pin 13. With the nail gripped tightly,the instrument can be used to drive the nail into the bone fragmentsacross the fracture to a .point where the end of the instrument issubstantially in contact with the shaft of the bone to which theprotruding end of the nail is to be fixed by means of screws and thelike. The handle 39 is then rotated further, bending the nail over thefulcrum l8, as shown in Fig. 5, until the projecting portion of the naillies parallel with the bone fragment to which it is to be secured.

The handle 39 is then rotated in the opposite direction to relieve thebending pressure on the nail and the fulcrum pin [3 can then beunscrewed and pulled out of the supporting sleeves l6 and [1, therebyleaving the nail in a position spanning the fracture. The nail can thenbe driven in fully until the downwardly bent portion thereof liesagainst the fragment of the bone to which it is to be fixed.

The ability of the device to be used in driving the nail and bending thenail after it has been partially driven into position is a greatadvantage for it makes possible the proper alignment of the relativelybent portions of the nail with the axis of the fractured bone and theoutside of one of the bone fragments. The device can, of course, be usedfor bending nails prior to insertion, and after bending them, it may beused to drive the nail almost completely into the bone to span thefracture.

The instrument is also provided with means for impacting fractures andfor withdrawing nails which are not inserted properly or accurate- 1y.The impacting mechanism may consist of a hammer 65 which consists of acup-like member 66 having a block of rubber 61 or the like mountedtherein and projecting beyond the cup and having a shaft portion 68which is fixed in the end of an internally threaded tube 69. A bearingsleeve 10 ,is fixed in the right-hand end of the handle In to receivethe member 69 and guide it for sliding movement axially of the handleIll. The guide sleeve 10 is provided with a spline H which engages in agroove 12 in the exterior of the sleeve 69 to prevent rotation of thesleeve.

The sleeve 69 is moved axially by means of a screw threaded shaft 13having an operating knob 14 threaded on its outer end and a collar 15pinned to it which has a sliding fit in the sleeve portion 35 on thescrew member 34. The collar 15 is spaced from the knob 14 so that thethreaded shaft 13 is capable of limited axial movement relative to thehandle In. This limited movement permits the knob 14 to be retracted andthen struck to cause the endwise movement of the hammer 65' to permitimpacting and proper seating of the bone fragments. Also, rotation ofthe knob 14 will project the rubber block 61 against the fracturedmember so that if the nail is gripped between the fulcrum pin 13 and theanvil members H and I2, sufiicient pressure can be exerted to withdrawthe nail partially or completely from the bone fragments.

By rotating the knob 14 in the opposite direction, the hammer block 51can be completely retracted within the end of the handle I0 and the knob14 drawn up tightly against the left end of the nut 44 so as to form afixed abutment which can be struck by the hand or with a mallet to drivethe nail into the bone fragment.

It will be understood that the apparatus described above will be formedof materials such as to render the device capable of sterilizationwithout corrosion. Such materials may be stainless steel, Monel andother oxidation and acidresisting materials. It will be understoodfurther that the instrument may be made of a'suitable size toaccommodate the specific type of nail required for the operation andthat other changes may be made in the device, depending uponrequirements, without departing from the invention. Accordingly, theform of the invention described herein should be considered asillustrative and not as limiting the scope of the following claims.

I claim:

1. An instrument for bending bone nails and the like comprising a handlemember, a pair of spaced apart arms extending obliquely from one end ofsaid handle member, a fulcrum pin detachably mounted in and extendingbetween said arms, a pair of anvil members mounted between said arms forangular movement about the axis of said pin, said anvil members beingspaced from said pin, pawl and ratchet elements on said handle memberand one of said anvil members to releasably retain said one anvil memberagainst movement in one direction and allow angular adjustment of saidone anvil member in either angular direction, a toggle mechanismconnected to the other anvil member, and means carried by and rotatablerelative to said handle member to collapse and straighten said togglemechanism and move said; other anvilmember angularly' around saidfulcrum pin.

2. An instrument for bending. bonenails and the like comprising a handlemember, a pair of spaced apartarms extending obliquely from one end ofsaid handle member, a fulcrum pinde: tachably mounted in and extendingbetween said arms, a pair of anvil members mounted between said arms forangular movement about the axis of said pin, said anvil members beingspaced from said pin, means to releasably retain one-of said anvilmembers against angular movement in one direction, a toggle mechanismconnected to the other anvil member, a member connected to said togglemechanism and slidable relative to said handle member to collapse andstraighten the'latter, an actuating member rotatably mounted in saidhandle member and having a handle thereon for rotating it, and meansconnecting said actuating member to said slidable member to slide thelatter upon rotation of said actuating member.

3. An instrument for bending bone nails and the like comprising a hollowhand1e member, a pair of spaced apart substantially parallel arms at oneend of said handle member and extending obliquely therefrom, a pair ofbearing sleeves mounted in said arms and extending inwardly therefrom inaxial alignment, a fulcrum pin detachably supported in said sleeves, apair of anvil members pivotally mounted on said bearing sleeves inspaced relation thereto for relative angular movement into and out ofalignment with each other, and means on said handle member for movingsaid anvil members relatively to bend a nail between them and saidfulcrum pin around said fulcrum pin.

4; An instrument for bending bone nails and the like comprising ahollowhandle member, a pair of spaced apart substantially parallel armsat one end of said handle member and extending obliquely therefrom, apair of bearing sleeves mounted in said arms and extending inwardlytherefrom in axial alignment, a fulcrum pin detachably supported in saidsleeves, a pair of anvil members pivotally mounted on said bearingsleeves in spaced relation thereto for relative angular movement intoand out of alignment with each other, means on said handle member formoving said anvil members relatively to bend a nail between them andsaid fulcrum pin around said fulcrum pin, an elongated threaded membernon-rotatably mounted'in said handle mem- I her and movable axiallythereon, an impacting;

head on one end of said threadedmembenadr jacent to said arms, andanother elongated threaded member rotatably and axially movable in saidhandle member, said threaded. members; being in threaded engagement andrelatively, to.- tatable tov project said impacting head, beyond saidarms andsaid fulcrumrpin and toretract;

said impacting head into said handle member.

5. An instrument, for bending bone nailsv and.

the like comprising. ahollow handle membena.

pair of spaced apart substantially parallel arms;

at one end of. said handle member andextending obliquely therefrom, afulcrum pindetachably supported in said arms,.a pairofanvilmemberspivotally. mounted on saidarms in spaced relation;

to said fulcrum pin for. relative angular move-:-

ment into and out of alignment witheach other,

EDWARD J HABOUSH'.

REFERENCES CITED The following references are of record in the file ofthis patent:

UNITED STATES PATENTS Number Name Date 896,207 Hazen Aug; .18; .1908.1,403,589 Cinquini Jan. 17,1922. 1,879,868 Breer Sept; 27,1932;1,889,239 Crowley Nov. 29,1932; 1,935,055 Morgan Nov; 14;.1933 2,127,185Parker Aug. 16,1938? 2,312,947 Westman Mar. 2, 1943. 2,341,489 TornborgFeb. 8; 194A;

FOREIGN PATENTS Number Country Date;

361,592 Germany Oct. 16,1922.-

